Illness beliefs and adherence in diabetes mellitus: a comparison between Tongan and European patients

N Z Med J. 2004 Jan 30;117(1188):U743.


Aim: The aim of this study was to determine whether there are cultural differences in the way in which Tongan and European people with Type 2 diabetes conceptualise their illness and treatment. The relationships between patients' illness and treatment perceptions and their adherence to self-care regimens were also assessed.

Methods: Participants completed either a Tongan or English version of a questionnaire, which included standardised measures of personal beliefs about diabetes and medication, and self-reported adherence. Information about the severity of patients' diabetes was obtained from patients' notes.

Results: Comparisons of glycosylated haemoglobin levels showed that Tongan patients had significantly poorer control over their diabetes than did European patients. They were also significantly more likely than European patients to perceive their diabetes as acute and cyclical in nature, uncontrollable, and caused by factors such as God's will, pollution in the environment, and poor medical care in the past. Tongan patients perceived less necessity for medication, and exhibited higher emotional distress related to their diabetes. The beliefs that characterised the Tongan patients tended to be associated with poorer adherence to diet and medication taking.

Conclusions: This study highlights the need for assessment of patients' personal and cultural beliefs about their illness. Understanding patients' perceptions may provide an avenue for improving adherence to self-care regimens.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Health / ethnology*
  • Cross-Cultural Comparison
  • Culture
  • Diabetes Mellitus, Type 2 / classification
  • Diabetes Mellitus, Type 2 / ethnology*
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / therapy
  • Europe / ethnology
  • Glycated Hemoglobin / metabolism
  • Humans
  • Middle Aged
  • Native Hawaiian or Other Pacific Islander*
  • New Zealand
  • Patient Compliance / ethnology*
  • Surveys and Questionnaires
  • Tonga / ethnology
  • White People*


  • Glycated Hemoglobin A